An informed consent with the risks and benefits of the procedure clearly stated should be obtained prior to the procedure.
Recommendations to reduce complications associated with CTFESI:
(1) Do not perform CTFESI unless there is a clear indication.
(2) Evaluate the patient prior to the procedure for conditions that may increase the risk of complications (coagulopathy, immunosuppression, etc).
(3) Select a nonparticulate corticosteroid such as dexamethasone.
(4) Use real-time fluoroscopy with contrast, preferably with digital subtraction for detection of arterial and venous blood flow.
(5) Use no or minimal sedation so that the patient can report any symptoms during the procedure (pain, warmth, headache, etc).
(6) Guide the needle tip toward the posterior foramen (anterior aspect of the superior articulate process) then advance very carefully under live fluoroscopy.
(7) Use extension tubing to reduce needle movement.
(8) Injecting a small test dose of a short-acting local anesthetic prior to injection of the corticosteroids.
The patient should be monitored for complications after the bolus has been administered. This will reduce the delay in detection if there is a problem.
